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Evidence suggests that video captured with a wearable video device (WVD) may augment or supplant traditional methods for assessing park use. Unmanned aerial systems (UASs) are used to assess human activity, but research employing them for park assessments is sparse. Therefore, this study compared park user counts between a WVD and UAS. A diverse set of 33 amenities (e.g., playground) in three parks were videoed simultaneously by one researcher wearing a WVD and another operating the UAS. Assessments were done at 12 p.m. and 7 p.m. on weekends, with one park evaluated on two occasions 7 days apart. Two investigators independently reviewed videos and reached consensus on the counts of individuals at each amenity. Intraclass correlation coefficients (ICCs) were used to determine intra- and interrater reliabilities. A total of 404 (M = 4.7; SD = 9.6) and 389 (M = 4.5; SD = 9.0) individuals were counted in the UAS and WVD videos, respectively. Absolute agreement was 86% (74/86) and 100% when no individuals were using the amenity. Whether using all 86 videos or only videos having people (48 videos), ICCs indicated excellent reliability (ICC = .99; p p p

Today’s technology could contribute substantially to measuring physical activity. The current study evaluated traditional and novel approaches for assessing park use. The traditional approach involved a trained observer performing the System for Observing Play and Recreation in Communities (SOPARC) at 14 parks while wearing a point-of-view, wearable video device (WVD). The novel approach utilized computer vision to count park users in the WVD videos taken during in-person SOPARCs. Both approaches were compared to criterion counts from expert reviews of the WVD videos. In the 676 scans made during in-person SOPARCs, 293 individuals were observed while 341 were counted by experts in the corresponding WVD videos. When using scans/videos having individuals in them (84 scans/videos), intra-class correlations (ICC) indicated good-to-excellent reliability between in-person SOPARC and experts for counts of total women and men, within age groups (except seniors), of Blacks and Whites, and within intensity categories (ICCs > .87; p p

For software applications in health coaching domains to be effective, it is vital that they address issues of privacy, modularity, scalability, individualization, data integration, transferability, coordination and flexibility. In this paper, we propose a novel generic multi-agent architecture which serves as a template for health coaching applications involving wearable sensors. Analyzer and communication modules allow different functionalities like goal formation, planning, scheduling, event detection, learning, inter-agent + human communication and long-term data collection, based on the capabilities of the underlying sensor platforms. To show the flexibility of our proposed architecture, we have successfully built two different health coaching systems with the proposed architecture: (1) a static system based on the Fitbit platform where the coaching is done at specific preset times to encourage increased physical activity, and (2) a dynamic system based on the Apple Watch platform where the smart coach adapts and learns when to intervene to encourage physical activity and reduce sedentary behavior.

The COVID-19 pandemic severely affected many aspects of human life. While most health agencies agree mask wearing and physical distancing reduce viral transmission, efforts to improve the assessment of these behaviors are lacking. This study aimed to develop a direct observation video method [Viral Transmission (VT)-Scan] for assessing COVID-19 transmission behaviors and related factors (e.g., environmental setting). A wearable video device (WVD) was used to obtain videos of outdoor, public areas. The videos were examined to extract relevant information. All outcomes displayed good to excellent intra- and inter-reliability with intra-class correlation coefficients ranging from 0.836 to 0.997. The majority of people had a mask (60.8%) but 22.1% of them wore it improperly, 45.4% were not physical distancing, and 27.6% were simultaneously mask and physical distancing non-compliant. Transmission behaviors varied by demographics with white, obese males least likely to be mask-compliant and white, obese females least likely to physical distance. Certain environments (e.g., crosswalks) were identified as “hot spots” where higher rates of adverse transmission behaviors occurred. This study introduces a reliable method for obtaining objective data on COVID-19 transmission behaviors and related factors which may be useful for agent-based modeling and policy formation.

Parks are ideal places for promoting physical activity, which is vital for achieving and sustaining good health. Thus, it is important to develop and provide the best methods for assessing aspects of parks that could influence physical activity. This study examined the use of high-tech video capture for describing park quality. Videos were obtained with a wearable video device (WVD) and an unmanned aerial system (UAS) at 28 and 17 parks, respectively. In-person audits of park attributes were performed using the Physical Activity Readiness Assessment (PARA) instrument while video was simultaneously captured. The PARA provides quality ratings of park attributes that range from poor to good. Kappa statistics were calculated to compare in-person PARA outcomes with PARA outcomes obtained by reviewing the WVD and UAS videos. Substantial and almost-perfect agreements were found between WVD and in-person PARAs on the quality of features and amenities and the severity of incivilities. Agreements between UAS and in-person PARAs on feature and amenity quality and incivility severity were unacceptable (mostly fair and moderate). In conclusion, being able to reliably assess park quality using video provides advantages over in-person assessments (e.g., retrospective analysis). In addition, it sets up the possibility of utilizing computer vision to automate the video analysis process.

Purpose: Consumer-grade wrist-worn activity monitors frequently include photoplethysmography (PPG) sensors for estimating heart rate (HR). The Fitbit Charge HR is marketed specifically for tracking fitness; therefore, HR accuracy is critical, especially during exercise. This study examined HR equivalency of the Fitbit Charge HR during continuous aerobic exercise. Method: Participants (N = 19) concurrently wore a Polar H1 and Fitbit Charge HR during a measurement visit that included seated rest (5 minutes), warm-up (5 minutes), continuous treadmill exercise (30 minutes), and cool-down (5–10 minutes). Mean HR differences were examined by protocol phase, total activity (i.e., warm-up, exercise, and cool-down combined), and the first, middle, and last 5 minutes of continuous exercise. Mean absolute percent error (MAPE), Bland-Altman plots, and 95% equivalence testing explained overall and individual HR agreement between devices. Results: The Fitbit Charge HR significantly underestimated HR for all measurement phases (all p ≤ .01) except cool-down (p > .33). HR agreement was notably weaker during warm-up (r = 0.66, d = 0.57) and differences were greatest for the first 5 minutes compared to the middle and end of exercise (6.94±2.16 beats per minute [bpm] vs. 1.76±0.59 bpm, and 1.74±0.58 bpm), F = 4.87, p = .04). Mean exercise HRs were equivalent between devices (±2.69 bpm, 95% CI: 1.41–3.97 bpm); MAPE was 1.96%. Conclusion: The Fitbit Charge HR is relatively accurate for measuring HR during continuous aerobic exercise. Whereas the accuracy of PPG-based HR appears limited at exercise onset, agreement improves throughout the exercise bout and HR differences are negligible.

Consumer-grade wearable activity devices such as Fitbits are increasingly being used in research settings to promote physical activity (PA) due to their low-cost and widespread popularity. However, Fitbit-derived measures of activity intensity are consistently reported to be less accurate than intensity estimates obtained from research-grade accelerometers (i.e., ActiGraph). As such, the potential for using a Fitbit to measure PA intensity within research contexts remains limited. This study aims to model ActiGraph-based intensity estimates from the validated Freedson vector magnitude (VM3) algorithm using measures of steps, metabolic equivalents, and intensity levels obtained from Fitbit. Minute-level data collected from 19 subjects, who concurrently wore the ActiGraph GT3X and Fitbit Flex devices for an average of 1.8 weeks, were used to generate the model. After testing several modeling methods, a naïve Bayes classifier was chosen based on the lowest achieved error rate. Overall, the model reduced Fitbit to ActiGraph errors from 19.97% to 16.32%. Moreover, the model reduced misclassification of Fitbit-based estimates of moderate-to-vigorous physical activity (MVPA) by 40%, eliminating a statistically significant difference between MVPA estimates derived from ActiGraph and Fitbit. Study findings support the general utility of the model for measuring MVPA with the Fitbit Flex in place of the more costly ActiGraph GT3X accelerometer for young healthy adults.

Estimating physical activity (PA) intensity and energy expenditure (EE) is a problem that typically requires the use of wearable sensors such as a heart rate monitor, or accelerometer. We investigate the accuracy of a computer vision system using videos recorded from a pair of wearable video glasses to estimate PA strength and EE automatically using age, gender, speed, and activity cues. Age and gender are obtained using the Deep EXpectation network, while activity is estimated from joint angles and movement speed. We also present results on a study of 50 participants performing four different activities while measuring corresponding features of interest such as height, weight, age, sex, and ground truth EE and PA strength data collected via accelerometer. We present both the results of each computer vision subsystem and overall accuracy of the PA strength estimation (89.5%) and the average EE difference (1.96 kCal/min).

Background A considerable proportion of outdoor physical activity (PA) is done on sidewalks and streets, necessitating the development of a reliable measure of PA performed in these settings. The Block Walk Method (BWM) is one of the more common approaches for this purpose. Although it utilizes reliable observation techniques and displays criterion validity, it remains relatively unchanged since its introduction in 2006. It is a nontechnical, labor-intensive, first generation method. Advancing the BWM would contribute significantly to our understanding of PA behavior. Objective This study will develop and test a new BWM that utilizes a wearable video device (WVD) and computer video analysis to assess PAs performed on sidewalks and streets. The specific aims are to improve the BWM by incorporating a WVD (eyeglasses with a high-definition video camera in the frame) into the methodology and advance this WVD-enhanced BWM by applying machine learning and recognition software to automatically extract information on PAs occurring on the sidewalks and streets from the videos. Methods Trained observers (1 wearing and 1 not wearing the WVD) will walk together at a set pace along predetermined 1000 ft sidewalk and street observation routes representing low, medium, and high walkable areas. During the walks, the non-WVD observer will use the traditional BWM to record the numbers of individuals standing, sitting, walking, biking, and running in observation fields along the routes. The WVD observer will continuously video the observation fields. Later, 2 investigators will view the videos to determine the number of individuals performing PAs in the observation fields. The video data will then be analyzed automatically using multiple deep convolutional neural networks (CNNs) to determine the number of humans in the observation fields and the type of PAs performed. Bland Altman methods and intraclass correlation coefficients (ICCs) will be used to assess agreement. Potential sources of error such as occlusions (eg, trees) will be assessed using moderator analyses. Results Outcomes from this study are pending; however, preliminary studies supporting the research protocol indicate that the BWM is reliable for determining the PA mode (Cramer V=.89; P Conclusions We expect the new approach will enhance measurement accuracy while reducing the burden of data collection. In the future, the capabilities of the WVD-CNN system will be expanded to allow for the determination of other characteristics captured in videos such as caloric expenditure and environmental conditions. International Registered Report Identifier (IRRID) PRR1-10.2196/12976

Obesity is a growing public health concern and is more prevalent among low-income and minority populations. Food insecurity may increase the odds of obesity in children. We investigated the association between food insecurity and obesity among low-income, Hispanic, mother-child dyads (n = 74). The United States Department of Agriculture 18-item Household Food Security Survey was used to determine food security status. The majority of households were food insecure (74 %) and one-third (30 %) of children were obese. Food insecurity increased the odds of childhood obesity (OR 10.2; 95 % CI 1.2, 85.5) with stronger associations found within households where mothers were also overweight/obese compared to normal weight (p-for interaction

Research examining sustainability of health promotion programs within organizational settings is limited. The Environmental Interventions in Residential Children’s Homes (ENRICH) was a structural intervention that trained Wellness Teams (WTs) within residential children’s homes (RCH) to target environmental changes that promote physical activity (PA) among residential youth. This study examines the sustainability of PA promoting environments and influences on sustainability within RCHs. A sustainability survey was administered to 14 RCHs 2 years after receiving ENRICH. Variables included sustainability of PA promoting environments, Organizational Influences, perceived organizational and individual benefits, and implementation of PA and general (i.e. Global) wellness activities. Activities reported as sustained and barriers were used descriptively to inform sustainability. Path analyses explained the relationship between sustainability influences and sustainability of PA promoting environments. Sustainability was found in 8 of 14 (57%) RCHs. Sustained activities reflected greater Global versus PA implementation. Global implementation mediated the relationship between Organizational Influences and sustainability, which may have been more easily achieved since Global activities were most likely controlled by WTs and did not require extensive organizational support from RCH administrators. Results highlight the importance of defining and assessing different implementation types when measuring sustainability and influences on sustainability within RCHs organizations.

ObjectivesAs a common form of sedentary behaviour, television viewing is associated with an increase in body mass index (BMI) as well as overall cardiovascular disease (CVD) risk. This study examined the extent to which meeting the recommended volume of weekly physical activity (PA) reduced the association between television viewing with the outcomes of BMI and CVD risk. A second aim was to determine the number of hours (ie, cut-point) of daily television viewing that conferred a higher BMI and CVD risk for a large population-based sample of adults.DesignPopulation-based, cross-sectional study.SettingUK Biobank recruited across 35 centres in the UK between 2006 and 2010.Primary outcomeCVD risk, as measured by the 30-year Framingham risk score.ResultsLinear regression models indicated that every additional hour of television viewing per day was associated with a 3% increase in CVD risk (aCoeff=0.03, d=0.16, pConclusionsThese data underscore the independent association between television viewing with cardiovascular risk and suggest that reducing television viewing to less than 2.5 hours per day, even in physically active adults, is a clinical and public health priority.

Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status. Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy. Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.

Fitbit devices are one of the most popular wearable activity monitors in the consumer market. They are considerably cheaper than many of their clinical grade counterparts. However, they utilize proprietary algorithms for estimation of physical activity (PA). This study aims to model the measures of PA as reported by the ActiGraph GT3X using Fitbit measures of steps, METs, and intensity level. Such a model relating the Fitbit to what would have been reported by the ActiGraph could enable researchers to use the Fitbit instead of the ActiGraph in some applications, thus reducing cost or increasing the number of subjects involved in a study. This paper describes a study in which a model of the Freedson VM3 physical activity classification was constructed that uses measures from the Fitbit device instead of the typically provided ActiGraph vector magnitude. The data from 19 subjects, who concurrently wore both the ActiGraph and Fitbit devices for an average of 1.8 weeks, was used to generate the minute level based model. Several modeling methods were tested; a naive Bayes classifier was chosen based on the lowest achieved error rate. That model reduces overall Fitbit to Acti-Graph errors from 19.97% to 16.32%, a notable improvement. More importantly, it reduces the errors in moderate to vigorous physical activity levels by 40%, eliminating a statistically significant difference between MVPA estimates provided by the Freedson VM3 and Fitbit Intensity scores. This justifies use of the Fitbit device in place of an ActiGraph device in some large scale studies, especially those where MVPA estimates are of importance.

Human activity can be measured through identification of bouts of activity. The Freedson cut point method used by ActiGraph has become one very common and well accepted standard for estimating times of continuous moderate to vigorous physical activity (MVPA). However, such methods do not directly apply to other data sources such as the Fitbit Flex, a wrist worn wireless pedometer. In previous research by the authors, a model was presented to improve the estimates of physical activity (PA) level in the Fitbit devices. This paper considers the estimates of activity bouts, building on the modeled PA level from the Fitbit Flex as compared to the results from the ActiGraph GT3X. The purpose of this paper is to compare the “gold standard” ActiGraph to modeled Fitbit Freedson methods and to establish normative values of expected errors in bout detection between the two devices and methods, both of which are proxy methods aimed at measuring actual physical activity levels. Here we compare bout identification using three measures, the ActiGraph Freedson method, Fitbit Intensity Score, and the modeled Fitbit Freedson using three different outcomes. First, we compare a baseline of per subject per day number and duration of bouts from an ActiGraph GT3X to the results found from using the same methods on the Intensity Score reported by Fitbit and the modeled Fitbit Freedson method. Next, we compare the difference in duration of bouts identified in each data source matched according to similar start and end times. Finally, we compare the bouts found from the three methods to bouts identified in a self report diary.

This study reports the effects of a structural intervention, ENRICH (Environmental Interventions in Children's Homes) which targeted the physical and social environment within residential children's homes (RCHs) to increase physical activity (PA) among residents (n=799). Participating RCHs (n=29) were randomized to Early (n=17) or Delayed (n=12) groups from 2004 to 2006 and 2006 to 2008, respectively. Children's PA was measured at three time periods (2004, 2006, 2008). Intent-to-treat analysis revealed no intervention impact on PA. Subsequent analyses used process evaluation data to group organizations into high and low PA-promoting RCHs to compare PA level, controlling for assignment to condition. Organizations with high PA-promoting environments were found to have more active youth. Utility of a comprehensive implementation monitoring plan and the need for formative assessment of organizational capacity is discussed.

The block walk method (BWM) is one of the more common approaches for assessing physical activity (PA) performed on sidewalks/streets, however, it is non-technical, labor-intensive, and lacks validation. This study aimed to validate the BWM and examine the potential for using a wearable video device (WVD) to assess PA occurring on sidewalks/streets. Trained observers (one wearing and one not wearing the WVD) walked together and performed the BWM according to a previously developed protocol along routes in low, medium, and high walkable areas. Two experts then reviewed the videos. A total of 1150 (traditional) and 1087 (video review) individuals were observed during 900 min of observation. When larger numbers of individuals were observed, the traditional method overestimated the overall number of people as well as those walking and sitting/standing, while underestimating the number of runners. Valid estimates of PA occurring on sidewalks/streets can be obtained by the traditional BWM in low and medium walkability areas and/or with non-common activities (cycling), however, its validity is questionable when sidewalks/streets use volume is high. The use of WVDs in PA assessment has the potential to establish new levels of accuracy, reduce resource requirements, and open up the possibility for retrospective analysis.

Objective: Internet-based physical activity (PA) interventions have shown promise, although findings remain equivocal. We used formative research to enhance a previously demonstrated program (Step into Motion) with the goal of developing an Internet program poised for dissemination. Methods: We conducted focus groups to identify Internet features targeted to theoretical constructs (social cognitive theory) predictive of PA behavior and rated as “useful for increasing PA.” We identified 5 theorytargeted Internet features as useful for increasing PA: (1) a PA tracking/logging calendar targeting self-monitoring and goal setting; (2) geographic mapping tools targeting perceived environment; (3) a discussion forum targeting social support; (4) exercise videos targeting observational learning; and (5) regular updates of peer PA progress targeting situation. We then tested the efficacy of the enhanced program (enhanced Internet, EI; N 25) in relation to publicly available PA Websites (standard Internet, SI; N 28) among 53 participants in a randomized controlled trial. Results: The EI arm increased PA in relation to the SI arm at 3 months (18.4 to 186.0 min/wk vs. 20.9 to 57.3 min/wk; p .03) but between-groups differences were not observed at 6 months (176.8 vs. 133.5 min/wk; p .44). EI participants maintained PA from 3 to 6 months (186.0 to 176.8 min/wk), and the SI group increased PA (57.3 to 133.5 min/wk). Conclusion: The EI program was efficacious at improving PA levels in relation to publicly available Websites initially, but differences in PA levels were not maintained at 6 months. Future research should identify Internet features that promote long-term maintenance.

BackgroundWearable activity monitors such as Fitbit enable users to track various attributes of their physical activity (PA) over time and have the potential to be used in research to promote and measure PA behavior. However, the measurement accuracy of Fitbit in absolute free-living conditions is largely unknown. ObjectiveTo examine the measurement congruence between Fitbit Flex and ActiGraph GT3X for quantifying steps, metabolic equivalent tasks (METs), and proportion of time in sedentary activity and light-, moderate-, and vigorous-intensity PA in healthy adults in free-living conditions. MethodsA convenience sample of 19 participants (4 men and 15 women), aged 18-37 years, concurrently wore the Fitbit Flex (wrist) and ActiGraph GT3X (waist) for 1- or 2-week observation periods (n=3 and n=16, respectively) that included self-reported bouts of daily exercise. Data were examined for daily activity, averaged over 14 days and for minutes of reported exercise. Average day-level data included steps, METs, and proportion of time in different intensity levels. Minute-level data included steps, METs, and mean intensity score (0 = sedentary, 3 = vigorous) for overall reported exercise bouts (N=120) and by exercise type (walking, n=16; run or sports, n=44; cardio machine, n=20). ResultsMeasures of steps were similar between devices for average day- and minute-level observations (all P values > .05). Fitbit significantly overestimated METs for average daily activity, for overall minutes of reported exercise bouts, and for walking and run or sports exercises (mean difference 0.70, 1.80, 3.16, and 2.00 METs, respectively; all P values < .001). For average daily activity, Fitbit significantly underestimated the proportion of time in sedentary and light intensity by 20% and 34%, respectively, and overestimated time by 3% in both moderate and vigorous intensity (all P values < .001). Mean intensity scores were not different for overall minutes of exercise or for run or sports and cardio-machine exercises (all P values > .05). ConclusionsFitbit Flex provides accurate measures of steps for daily activity and minutes of reported exercise, regardless of exercise type. Although the proportion of time in different intensity levels varied between devices, examining the mean intensity score for minute-level bouts across different exercise types enabled interdevice comparisons that revealed similar measures of exercise intensity. Fitbit Flex is shown to have measurement limitations that may affect its potential utility and validity for measuring PA attributes in free-living conditions.

Background: We used a composite variable composed of insurance status, income, and race/ethnicity to investigate access-enhancing programs as a possible reason for “reversals of association” and large percent changes (LPC), between race/ethnicity and cancer screening, when comparing the unadjusted and adjusted ORs. Methods: Data were from women aged 40–64 years, using the combined 2008 and 2010 Behavioral Risk Factor Surveillance System surveys. Recent mammography was within the past 2 years, and recent Pap testing was within the past 3 years. Initial analyses using all variables singly were followed by analyses that used the composite variable with the remaining covariates. Results: Analyses with race/ethnicity singly indicated reversals of association for Hispanic women and higher estimated screening for black and Hispanic women than for white women. Analyses with the composite variable found no reversals of association, but there were several LPCs for Hispanic and black women, for lower income, and for uninsured women. White, uninsured, lower income women were among those with the lowest utilization. Conclusions: Results were consistent with the possibility that access-enhancing programs for lower income, uninsured and often non-white women can lead to overestimates of screening, reversals of association, and LPCs in multivariable analyses. Attention should be given to identifying LPCs to unadjusted ORs. Lower income, uninsured, white women are also a group at risk of extremely low mammography and Pap test utilization. Impact: Combining variables to create better-targeted population subgroups may help in the interpretation of analyses that produce reversals of association and LPCs for correlates of cancer screening utilization. Cancer Epidemiol Biomarkers Prev; 21(9); 1450–7. ©2012 AACR.

Background:An important influence on youth physical activity (PA) is the provision of instrumental social support (ISS) by parents and other adults. Limited research exists about factors that influence parental provision of ISS for youth PA. Following a theory-based conceptual model, a measure for assessing ISS for PA was developed from elicitation survey results. The purpose of this paper is to describe elicitation methodology and ISS instrument development.Methods:Parents (N = 37) of children (5–14 years) responded to open-ended questions assessing modal beliefs about their provision of ISS for PA regarding a) positive/negative beliefs, b) normative beliefs, c) self-efficacy (SE), and d) ISS for PA. Data were analyzed qualitatively.Results:ISS behaviors reported by parents include enroll/sign-up youth for structured PA, paying expenses for participation in structured/unstructured PA, and providing transportation for unstructured/structured PA. Child health and fitness (benefits), and time/scheduling conflicts (barriers) were most frequently reported behavioral beliefs. Family members were most frequently identified as specific referents for normative beliefs. Final instrument scales yielded moderately high internal consistency reliability scores.Conclusions:When developing scales not previously assessed in a population, eliciting modal beliefs about a behavior is an important formative step in instrument development.

OBJECTIVES To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA. METHODS Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy. RESULTS Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy. CONCLUSIONS Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education.

Objective To systematically review definitions and descriptions of computer literacy as related to preventive health education programs. Method A systematic review of the concept of computer literacy as related to preventive health education was conducted. Empirical studies published between 1994 and 2007 on prevention education programs with a computer literacy component were found using medical/health, communication, information science and education databases. Results A total of 464 citations were retrieved from 12 databases using specific search terms. Six articles met the inclusion criteria of: search terms in title, abstract and/or key words; peer-reviewed; original empirical research; and written in English. Conclusion Findings show limited and inconsistent definitions of computer literacy in the literature on computer-based prevention interventions. Without a clear construct of computer literacy, it will be difficult to determine the impact of such programs on health information seeking and, ultimately, health status.

Objectives To examine the association between self-efficacy, social support, and fear of movement with physical activity and function at baseline and after 12 weeks of physical therapy. Design Nonrandomized cohort study, repeated-measures design. Setting Outpatient rehabilitation clinic within the general community. Participants Adults (N=49) undergoing outpatient physical therapy for total knee replacement (TKR). Interventions Not applicable. Main Outcome Measures Self-efficacy for exercise (SEE), fear of movement, leisure-time physical activity (LTPA), 6-minute walk test (6MWT), and Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS) were assessed at baseline and 12 weeks. Results Mean functional change scores significantly increased at 12 weeks for the 6MWT (95% confidence interval [CI], 42.3–106.2), KOS-ADLS (95% CI, 12.7–23.3), and LTPA (95% CI, 6.5–26.1). Self-efficacy and fear of movement were not significantly associated with function at baseline or 12 weeks. Participants with lower SEE had 6 fewer metabolic equivalents per week of improvement in LTPA than those with high self-efficacy (95% CI, −27.9 to 14.8), and those with high fear of movement had 26.1m less improvement in the 6MWT than those with low fear of movement (95% CI, −42.2 to 94.5). Most participants reported having no family or peer support for exercise. Conclusions Physical therapy for TKR improves physical function and self-reported physical activity. High fear of movement and low SEE may be associated with less improvement in physical activity and function over time.

Identifying correlates of colorectal cancer screening (CRCS) is critical for cancer control and prevention. Classification tree analysis (CTA) is a potentially powerful analytic tool that can identify distinct population subgroups for which CRCS is influenced by any number of multivariable interactions. This study used CTA to identify correlates of CRCS for exclusive population subgroups. Data were obtained from the 2007 Health Information National Trends Survey (HINTS) and analyzed in 2014. CTA was employed to determine the association between demographic (n = 11), psychosocial (n = 6), and numeracy (n = 3) variables and CRCS status of adults ≥50 years (n = 3,769). Overall CRCS rate was 66.9 %. Level of doctor avoidance (three categories) was the initial splitting variable, leading to a total of 21 terminal node subgroups of CRCS utilization: (1) avoid doctor, not for fear of illness/death [n = 625 (16.5 %), four subgroups]; (2) avoid doctor, fear illness/death [n = 366 (9.7 %), two subgroups]; (3) do not avoid doctor [n = 2,778 (73.7 %), 15 subgroups]. Doctor avoidance was an important behavioral influence on CRCS adherence. Use of CTA to identify unique characteristics within population subgroups has merit for tailoring future intervention strategies. Community-based approaches may be effective for reaching individuals who avoid routine doctor visits.

Health literacy (HL) is associated with preventive health behaviors. Self-efficacy is a predictor of health behavior, including physical activity (PA); however, causal pathways between HL and self-efficacy for PA are unknown, especially among Latinas who are at risk for chronic disease. To explore this potential relationship, secondary analyses were conducted on data [Shortened Test of Functional Health Literacy in Adults (STOFHLA), PA self-efficacy, and socio-demographics] from a 6-month, randomized controlled trial of a print-based PA intervention (n = 89 Spanish-speaking Latinas). Linear regression models revealed associations between HL and baseline self-efficacy in addition to changes in self-efficacy at 6-months. After controlling for significant covariates, higher HL scores were associated with lower baseline PA self-efficacy. Regardless of treatment assignment, higher HL scores at baseline predicted greater changes in PA self-efficacy at 6-months. HL may contribute to Latinas’ improved PA self-efficacy, though further research is warranted.

Background. Mortality from prostate cancer (PrCA) in African-American (AA) men is significantly higher than in European-American (EA) men. Methods. Purposive sampling identified 25 AA men ≥45 years for interviews/focus groups. Participants were asked about cancer information-seeking behaviors, capacity to use information, and recommendations for messages and message delivery. Transcripts were analyzed for themes about PrCA communication. Results. Barriers to information seeking were fear, poor resources, and limited family communication. Participants requested messages stressing men’s “ownership” of PrCA delivered “word-of-mouth” by clergymen, AA women, and AA PrCA survivors. Conclusions. Direct and timely messages about PrCA should be developed for AA men.

Prostate cancer (PrCA) is the most diagnosed cancer among men in the United States, especially among African American (AA) men. The purpose of this formative study was to explore the implications of applying Nutbeam's multidimensional health literacy framework to AA men's understanding of PrCA information. Participants were 25 AA men aged 45 and older in South Carolina. Their functional health literacy was assessed using two modified Cloze tests and the Shortened Test of Functional Health Literacy in Adults (S-TOFHLA). Men also participated in interviews or focus groups during which they were asked questions about PrCA risk, prevention, and screening. Transcripts were reviewed for recurrent themes and analyzed qualitatively using NVivo7. Mean S-TOFHLA was 28.28 (+/-1.98), implying "adequate" comprehension. Mean Cloze was .71 (+/-.05) for a Grade 8 document and .66 (+/-.04) for a Grade 13 document, also showing "adequate" comprehension. Cloze scores for the Grade 8 resource were lower for participants with less education (P = .047). Despite having satisfactory literacy test scores, results from interviews and focus groups revealed participants' limited understanding and misconceptions about PrCA risk. Many wanted information about screening and family history delivered word-of-mouth by AA women and church pastors as few of them had ever received or actively sought out PrCA resources. Using Nutbeam's framework, gaps in health literacy which were not adequately captured by the validated tools emerged during the interviews and focus groups. Study findings provide important implications for PrCA communication with AA men to correct misperceptions about cancer risk and motivate preventive behaviors.